Does radiology PP have secondary income streams?

[Anakinmemer]

Considering different specialties right now and one of the big positives of derm and ophtho to me is that they remain very business oriented. It is possible to make an additional 6 or even 7 figures based on other practice income streams/the work of other employees at the practice. Your compensation is not necessarily defined by how much you work.

It seems that specialties like radiology (and anesthesia) this is much less the case (could be wrong). In that you're really only going to be making however much you want to work and there's much less opportunity to run a practice as a business. Your own work is your income stream.

So, is that true? Or are there other revenues that practices bring that allow partners to make 7 figures (without working 80 hours a week) similar to derm/ophtho

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[guytakingboards]

7 figures in radiology is uncommon and is going to be a very busy practice and/or in the boonies.

As far as secondary income streams, they're fairly common in PP radiology. The most common one is the PP group owning the imaging center(s) that they read for. That way the group collects both the professional fee (rad interpretation) and technical fee (money related to cost of equipment/maintenance/personnel/etc...).

Other less common ones include real estate (related or not related to the land under the imaging centers) and billing services

 

[Neopolymath]

Considering different specialties right now and one of the big positives of derm and ophtho to me is that they remain very business oriented. It is possible to make an additional 6 or even 7 figures based on other practice income streams/the work of other employees at the practice. Your compensation is not necessarily defined by how much you work.

It seems that specialties like radiology (and anesthesia) this is much less the case (could be wrong). In that you're really only going to be making however much you want to work and there's much less opportunity to run a practice as a business. Your own work is your income stream.

So, is that true? Or are there other revenues that practices bring that allow partners to make 7 figures (without working 80 hours a week) similar to derm/ophtho

I came into radiology with similar questions as a business owner and someone who has little desire to make others rich through my labor (treadmill).

Ultimately, there is commonly vertical integration of business but it isn't nearly as entrepreneurial IMO in the sense I believe you are asking about. The main reason being is that it seems like most of the revenue streams have already been established in most areas so when you have a job you aren't going to make salary and then start something new to add some cash on top if that makes sense. It's probably already been done if not in the middle of nowhere.

Personally, my other business ventures made this a non-issue and I enjoy many aspects of radiology so I pursued it. If I was looking to create significant ancillary income and build a business solely inside my specialty then I would not have chosen radiology because the barrier to entry to the market as a new entity is too high.

All this said, I'm just a resident who has a background in entrepreneurship and spoke hard numbers with a handful of contacts about this subject before pulling the trigger. The PP attendings might be able to tell you what I'm unaware of.

Bottom line opinion: Go do ophtho, derm, ENT if this is priority 1 and you will walk the walk.

 

[sloh]

I came into radiology with similar questions as a business owner and someone who has little desire to make others rich through my labor (treadmill).

Ultimately, there is commonly vertical integration of business but it isn't nearly as entrepreneurial IMO in the sense I believe you are asking about. The main reason being is that it seems like most of the revenue streams have already been established in most areas so when you have a job you aren't going to make salary and then start something new to add some cash on top if that makes sense. It's probably already been done if not in the middle of nowhere.

Personally, my other business ventures made this a non-issue and I enjoy many aspects of radiology so I pursued it. If I was looking to create significant ancillary income and build a business solely inside my specialty then I would not have chosen radiology because the barrier to entry to the market as a new entity is too high.

All this said, I'm just a resident who has a background in entrepreneurship and spoke hard numbers with a handful of contacts about this subject before pulling the trigger. The PP attendings might be able to tell you what I'm unaware of.

Bottom line opinion: Go do ophtho, derm, ENT if this is priority 1 and you will walk the walk.

Do you mind sharing your other business ventures?

 

[vm26]

Considering different specialties right now and one of the big positives of derm and ophtho to me is that they remain very business oriented. It is possible to make an additional 6 or even 7 figures based on other practice income streams/the work of other employees at the practice. Your compensation is not necessarily defined by how much you work.

It seems that specialties like radiology (and anesthesia) this is much less the case (could be wrong). In that you're really only going to be making however much you want to work and there's much less opportunity to run a practice as a business. Your own work is your income stream.

So, is that true? Or are there other revenues that practices bring that allow partners to make 7 figures (without working 80 hours a week) similar to derm/ophtho

Having employees (mid-levels) working for you is a double edge sword. Radiology job market is so open now precisely due to the fact that mid-levels cannot replace us (or even doing a significant amount of what we do) at this point...From what I've heard P/E has started their infiltration into derm (use of mid-levels makes this easier). Unsure of ophthalmology but I would guess that the average rad makes more than the average optho (but could be wrong).

Owning equipment used to be the golden goose but thats been slashed by CMS. With this said, if you get set-up in a traditional PP with solid compensation/wRVU, you can still do pretty well working a 45 hour work week and have 10 weeks off etc. A former group of mine in a large metro coastal city worked 40 hour work weeks and made high-6 (with IR making 7 given all their call). Simply have to read more volume.

Regardless, the future of medicine is really up in the air. I myself would recommend dentistry. Many places in the country where you can set-up shop and take cash only (especially if you're a specialist or have a certain niche), or be very selective in what type of insurance you take. You do need the entrepreneurially spirit though to manage all aspects of your practice/small business

 

[giguerex35]

not to derail this thread but how possible is it to make 600k as a radiologist just doing reads and without a side gig. even better if you can comment on the liklihood of doing this as tele

 

[Melkor]

Very possible. There's a wide range in salaries and even wider range in vacation but it's not terribly difficult to find a group where its 1 year to partner, partners avg 600-700k with 10-17 weeks vacation if you are flexible in location. Highest I've heard is 1.2 mill without owning equipment/side gigs but that was with little vacation and long days. 600k tele is going to be rare but not impossible if your faster than 90-95% of other rads and like to work.

 

[vm26]

not to derail this thread but how possible is it to make 600k as a radiologist just doing reads and without a side gig. even better if you can comment on the liklihood of doing this as tele

I've received recruiter emails for tele in high 6-figures (though to be fair, one is going to work high volume for this)...Pro fee (meaning everything minus the technical fee which goes to whoever owns the equipment) varies from around 50-70/RVU. Think average production for PP RVU/year is around the 11-12K range. 17-20K RVUs is likely 95th% which some groups manage to do but personally would find soul-crushing. So despite "death by a thousand cuts" from CMS, its still a pretty solid gig (as long as you avoid Private Equity)

 

[giguerex35]

Very possible. There's a wide range in salaries and even wider range in vacation but it's not terribly difficult to find a group where its 1 year to partner, partners avg 600-700k with 10-17 weeks vacation if you are flexible in location. Highest I've heard is 1.2 mill without owning equipment/side gigs but that was with little vacation and long days. 600k tele is going to be rare but not impossible if your faster than 90-95% of other rads and like to work.

another question, how possible is it to work a regular rads job and do some tele on the side to make an extra couple bucks maybe 1-2X a week or during vacation from your other job

 

[giguerex35]

I've received recruiter emails for tele in high 6-figures (though to be fair, one is going to work high volume for this)...Pro fee (meaning everything minus the technical fee which goes to whoever owns the equipment) varies from around 50-70/RVU. Think average production for PP RVU/year is around the 11-12K range. 17-20K RVUs is likely 95th% which some groups manage to do but personally would find soul-crushing. So despite "death by a thousand cuts" from CMS, its still a pretty solid gig (as long as you avoid Private Equity)

another question, how possible is it to work a regular rads job and do some tele on the side to make an extra couple bucks maybe 1-2X a week or during vacation from your other job

 

[clutch21]

another question, how possible is it to work a regular rads job and do some tele on the side to make an extra couple bucks maybe 1-2X a week or during vacation from your other job

Very possible. Many groups have internal moonlighting to make more if you want (e.g. taking extra call shifts or selling weeks of vacation). I also know several people who moonlight externally.

 

[forchinet121]

Do you mind sharing your other business ventures?

“I inherited a small 8 million dollar business from my father”

 

[Neopolymath]

“I inherited a small 8 million dollar business from my father”

I'll respond soon lol.

 

[vm26]

another question, how possible is it to work a regular rads job and do some tele on the side to make an extra couple bucks maybe 1-2X a week or during vacation from your other job

There's a rad shortage so many groups offer internal moonlighting. My group does this and the hourly rate is consistent with what we typically make per wRVU. Pretty nice perk to have, win-win for both the group and rads that participate...Now if you're talking about working tele from home for some other group in some other state things get a bit more complicated and you will also likely be reading at a discounted rate as an random per-diem outsider. Unlikely you could just arbitrary log on whenever you felt like it due to cost of getting you credentialed (not the case with internal moonlighting). You would also likely have to get permission from your FT local job.

 

[vm26]

“I inherited a small 8 million dollar business from my father”

Picking the right parents is a really important decision. It's amazing how so many people mess this up!

 

[Chemdude]

My private practice group pays $2500 to cover a 9 hr shift reading ~70 RVUs. You can easily find a job paying $250-350/hr doing locums.

 

[GadRads]

My private practice group pays $2500 to cover a 9 hr shift reading ~70 RVUs. You can easily find a job paying $250-350/hr doing locums.

Is this 70 RVUs or 70 wRVUs?

 

[Chemdude]

Is this 70 RVUs or 70 wRVUs?

RVUs

 

[Neopolymath]

Do you mind sharing your other business ventures?

Better late than never... Here is a slightly vague list (for privacy) that I am currently involved in or was involved in before medicine:

Real estate (duh)
Storage (units/boats/rvs/cars)
Car lots
Mechanic shops/enthusiast car parts
Laundromats
Rental/charter of boats and other toys
Aquaculture
Artisan work (think overpriced Etsy stuff)
Drop shipping companies back when it was new
Mobile welding
Woodworking
Boat repair/surveying

I'm a silent partner or essentially cruise control on several of these during residency. Will probably go hard again 5 years out as an attending when I feel competent.

 

[Neopolymath]

This is all awesome, thanks for sharing. Which one has had the best ROI for you and which is the most enjoyable?

Real estate had excellent ROI for just about everyone in the past decade+ and even people who aren't incredibly RE savvy (me) did well. It can be passive with some luck too. I will not pursue much RE ventures in the next 5-10 years. Will likely try some syndications as detailed on some SDN threads just for the experience. Where you live really changes the dynamics of being the owner and dealing with RE versus REITs or syndication. Probably a dead clock scenario and luck but best ROI.

Most enjoyable? Many of these are enjoyable but the reward from things like woodworking and aquaculture is unmatched personally and professionally.

Anyways that's enough threadjacking.

 

[Splenda88]

Is there anyone here that makes 700k+ working only with no side hustle?

 

[MadRadLad]

Is there anyone here that makes 700k+ working only with no side hustle?

It's not uncommon in private practice, particularly in more rural areas, but at that point usually reading more cases IS the side hustle.

 

[Splenda88]

It's not uncommon in private practice, particularly in more rural areas, but at that point usually reading more cases IS the side hustle.

I feel like you spend too much energy trying to make money from side hustles.

I know time is finite but it seems like it's easier to work 3 extra days a month to make an additional 100k/yr.

Seeing how much money you guys earn make me think I should have done rad instated of IM. Ceiling for IM (hospital medicine) is 450-500k, but it appears to be ~800k for rad. Then again, I did not want to do 6 yrs (5+1) of postgrad training.

Anyway, 400k is not that bad working 17.5 days/month from 7a-6pm when ~8 hrs is actual work and the rest of the time is spent horsing around.

 

[Neopolymath]

I feel like you spend too much energy trying to make money from side hustles.

I know time is finite but it seems like it's easier to work 3 extra days a month to make an additional 100k/yr.

Seeing how much money you guys earn make me think I should have done rad instated of IM. Ceiling for IM (hospital medicine) is 450-500k, but it appears to be ~800k for rad. Then again, I did not want to do 6 yrs (5+1) of postgrad training.

Anyway, 400k is not that bad working 17.5 days/month from 7a-6pm when ~8 hrs is actual work and the rest of the time is spent horsing around.

Side hustle should be enjoyable, provide diversification, and be working toward more passive income. If/when medicine goes to total **** then I will have options to revert completely to my prior career and lifestyle. If I get tired of medicine I can scale back and then keep expanding my other ventures. The whole point is flexibility.

I think if you aren't getting 1 but preferably 2 or 3 of the above goals then you should quit the side hustle and reevaluate what you are doing. For most physicians without any real skills just doing more shifts be it with your group or as locums is the path to more cash and a change of scenery that makes the most sense by far.

 

[Splenda88]

Side hustle should be enjoyable, provide diversification, and be working toward more passive income. If/when medicine goes to total **** then I will have options to revert completely to my prior career and lifestyle. If I get tired of medicine I can scale back and then keep expanding my other ventures. The whole point is flexibility.

I think if you aren't getting 1 but preferably 2 or 3 of the above goals then you should quit the side hustle and reevaluate what you are doing. For most physicians without any real skills just doing more shifts be it with your group or as locums is the path to more cash and a change of scenery that makes the most sense by far.

I predict it won't take more than 10 yrs for that to happen. There is no freaking way the system can be bleeding that much money while remaining sustainable.

Hopefully I got my 2+ mil plus a paid off home before s... hits the fan. Not a big baller like you guys so I don't need 5+ mil to get out of the rat race.

 

[forchinet121]

I predict it won't take more than 10 yrs for that to happen. There is no freaking way the system can be bleeding that much money while remaining sustainable.

Hopefully I got my 2+ mil plus a paid off home before s... hits the fan. Not a big baller like you guys so I don't need 5+ mil to get out of the rat race.

They’ve been saying this nonsense for decades

 

[Rad2013]

Is there anyone here that makes 700k+ working only with no side hustle?

Easily.

 

[sevo00]

Is there anyone here that makes 700k+ working only with no side hustle?

i'm not a radiologist but my buddy from med school is. Partners in his group make 750k+ with one even making seven figures because he takes less vacation.

 

[Splenda88]

i'm not a radiologist but my buddy from med school is. Partners in his group make 750k+ with one even making seven figures because he takes less vacation.

Getting even more upset for not doing radiology. I guess I was not thinking long term.

 

[GadRads]

I feel like you spend too much energy trying to make money from side hustles.

I know time is finite but it seems like it's easier to work 3 extra days a month to make an additional 100k/yr.

Seeing how much money you guys earn make me think I should have done rad instated of IM. Ceiling for IM (hospital medicine) is 450-500k, but it appears to be ~800k for rad. Then again, I did not want to do 6 yrs (5+1) of postgrad training.

Anyway, 400k is not that bad working 17.5 days/month from 7a-6pm when ~8 hrs is actual work and the rest of the time is spent horsing around.

If you worked a bit more, you would make as much as the average rads. I know a hospitalist who made $500K+ last year by taking an extra week of work on some months. That is the average in my group, but we only have 10 weeks off per year. The average pay for rads is around $500K, and trust me, rads earn their money. If the average was 300-350K you would see decreased interest in the field and several would quit as the amount of work would not be justifiable for the pay. I personally would be in pharma or some government job if the pay was that low. One of my best friends who skipped residency works in pharma and makes $320-360K depending on bonuses, and he is still early-career.

I interviewed at a large independent private practice group in a very desirable area that had an average minimum of 65 wRVU per day. I saw the wRVU counter on one of the docs computers. You wouldn't leave until you hit that number. Some docs even read more for bonuses, and several had to skip lunch, ate lunch at their desks, and/or stay late till 7 pm to finish the work. I believe the average doc earned $600-650 with 9 weeks of vacation. I did not take the job. But they seemed happy. My current group averages 50-55 wRVU per day, but there are no daily minimums, which I like. Some days I read under 50, and on others over 70.

If money is your motivation, you are currently doing as well as the average rad (if not even better accounting for time off and actual hours worked). I did a real prelim IM year, and I found radiology training more mentally demanding that IM. As an attending, some shifts are so crazy that I need 2 hrs to mentally decompress after work. The liability is also higher in rads. Think of what it takes to read 50 CTs/MRs and 20-60 X-rays/ultrasounds of varying complexity usually with unhelpful and misleading indications like "r/o abscess, stat, stroke", and to do this in 8-9 hours and not miss clinically significant findings. It is not trivial. I thought about doing IM and possibly GI or cards, but decided against it as I did not like clinic and found clinical work to be frustrating and boring at times (non-adherent patients, paper work, dispo, med recs, etc).

Neurosurgery makes a lot and it is not uncommon for some to make 7 figures, but the work does not interest me, and I don't want that lifestyle. On the other hand, I love radiology and currently could not see myself in another specialty.

 

[forchinet121]

Getting even more upset for not doing radiology. I guess I was not thinking long term.

What you’re saying doesn’t really make sense, radiology is completely different than IM which is completely different than neurosurgery, if you’re obsessed with money might as well become a spine surgeon and make 1M+. They’re completely different fields and if you don’t like them you won’t be happy, the difference between 350k and 750k is not that much in terms of happiness and quality of life.

 

[Rads4lyfe]

Is there anyone here that makes 700k+ working only with no side hustle?

Not uncommon. Easier to find in middle of nowhere, but you can find good jobs in nice cities. My group in a big coastal city clears that. You definitely have to work for the money though.

 

[GadRads]

Not uncommon. Easier to find in middle of nowhere, but you can find good jobs in nice cities. My group in a big coastal city clears that. You definitely have to work for the money though.

What is your average daily work RVU? How many weeks vacation/days off?